EFFECTS OF METHYLPREDNISOLONE AND CYCLOPHOSPHAMIDE PULSE THERAPY ON RENAL INFILTRATING CELLS IN PATIENTS WITH CRESCENTIC GLOMERULONEPHRITIS

Objective To investigate the effects of pulse methylprednisolone (MP) and monthly intravenous cyclophosphamide (CTX) therapy (MP + CTX) on r enal infiltrating cells in patients with rapid progressive glomerular nephritis (RPGN). Methods Twelve patients with RPGN (> 50% crescents) were given MP + CTX therapy and received repeated renal biopsies withi n 4 to 12 weeks after MP + CTX treatment. Seven were diagnosed as type II RPGN, including one case of IgA nephropathy, 2 cases of idiopathic RPGN and 4 cases of lupus nephritis and five were diagnosed as type I II RPGN, including 2 cases of idiopathic RPGN and 3 cases of vasculiti s. The changes of infiltrating CD4(+), CD8(+), CD68(+) and proliferati ng cell neuclear antigen-PCNA(+) cell levels were determined by four P AP method in glomeruli and interstitium. Results In the patients befor e MP + CTX therapy, there were higher levels of infiltrating CD4(+) an d CD8(+) cells (306 +/- 118 and 223 +/- 98.4 Num/mm(2)) in renal inter stitium, CD68(+) cells (17.2 +/- 9.95 Num/G) in glomeruli and (1120 +/ - 229 Num/mm(2)) in interstitium, and PCNA(+) cells (7.56 +/- 3.57 Num /G) in glomeruli and (17.6 +/- 6.85 Num/mm(2)) in interstitium as comp ared with those in the patients after MP + CTX therapy (CD4(+)/CD8(+) cells were 171 +/- 87.5/121 +/- 38.4 Num/mm(2), CD68(+) cells were 9.0 4 +/- 4.33 Num/G and 600 +/- 107 Num/mm(2), and PCNA(+) cells were 2.0 41 +/- 1.43 Num/G and 9.40 +/- 4.45 Num/mm(2)). These changes were ass ociated with improving renal dysfunctions (the levles of serum creatin ine and proteinuria decreased gradually from 766 +/- 356 to 284 +/- 19 2 mu mol/L and 2.60 +/- 1.46 to 1.29 +/- 0.85 g/day). Conclusions Our data indicate that the renal infiltrating cells may play an important role in renal injury in patients with RPGN. The effects of MP + CTX th erapy on improving renal dysfunctions may partially contribute to its amelioration of infiltrating cells in renal tissues. The degrees of CD 4(+), CD68(+), and PCNA(+) cells in the kidney may be useful indicator s of MP + CTX therapy for RPGN.